Congress Is Trying Repeal, Fix And Transform Obamacare At The Same Time

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Robert Donachie Capitol Hill and Health Care Reporter
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Republicans in the House and Senate are torn over what to do about Obamacare, simultaneously putting forth plans to repeal and replace and another to patch up the hallmark health care legislation.

The two main Republican proposals floating around Capitol Hill that are catching attention include: a bill to repeal large portions of Obamacare (known as the Graham-Cassidy bill) and a bipartisan piece of legislation to shore up insurance markets and patch up Obamacare (chaired by Sens. Lamar Alexander of Tennessee and Patty Murray of Washington).

While Republicans mull over these proposals, nearly a dozen Senate Democrats are rallying behind legislation that aims to expand Medicare and create a single-payer health care system in America. The bill is known as “Medicare-For-All,” and is championed by Sen. Bernie Sanders of Vermont.

Republican Sens. Lindsey Graham of South Carolina, Bill Cassidy of Louisiana and Dean Heller of Nevada are going to have to convince Senate Majority Leader Mitch McConnell that their proposal — a last-ditch effort to repeal Obamacare — is more worth the political capital and legislative effort than Alexander’s bill, which aims to stabilize the Affordable Care Act state exchanges and strengthen the individual insurance marketplace. McConnell put forth three versions of Obamacare reform in July, and each fell short of the 50 vote threshold needed under reconciliation rules in a procedural vote.

Republican leadership in the Senate has under 17 legislative days to pursue either proposal through the Senate’s budget reconciliation process, which expires on Sept. 30.

It remains unclear whether McConnell will put forth either bill for a vote, but each present alternative versions of health care reform to the single-payer system that Sanders is planning on pushing through Congress.


Graham, Cassidy, Heller and Sen. Ron Johnson of Wisconsin are scheduled to introduce their Obamacare repeal bill late Wednesday morning.

The senators are planning to use budget reconciliation rules — a legislative loophole that requires only 50 yes votes — to pass their bill. The clock runs out on the reconciliation rules at the end of September, which means the legislators have very little time to move their bill through both chambers of Congress, finalize it, and have it on President Donald Trump’s desk for approval.

The legislation would replace Obamacare’s Medicaid expansion, subsidies for private insurance companies (cost-sharing reductions) and tax-credits for middle-income Americans with block grants. The new funding mechanism would start in 2020 and would provide states with the opportunity to apply for grants from a pool of $136 billion. That pool would grow nearly 50 percent in six years, reaching $200 billion in 2026.

The legislation allocates a set portion of funds for states to spend on health care programs. Funds would be dispersed based on how much they receive under Obamacare. The bill would also, for the first time in history, place a federal spending cap on Medicaid.

Congress would have to act again in 2026 to continue funding for the bill, which is written with only a 10-year horizon.

Alexander-Murray Fix For Obamacare

Senate Health Committee Chairman Lamar Alexander kicked off a series of hearings last week that are focused on finding a way to both stabilize the Affordable Care Act and individual health insurance marketplaces and prevent premiums from soaring in 2018. Soaring premiums have been a persistent problem for individuals enrolled on the Obamacare state exchanges. Alexander hopes to have a piece of legislation crafted by Sept. 15.

Alexander is planning to put forth a bill that would continue funding Obamacare subsidy payments called cost-sharing reductions (CSRs). CSRs help cover the cost of deductibles for low-income consumers on the exchanges, allow consumers to purchase catastrophic health care plans, and allow for the expansion of state waivers. The waivers — commonly known as 1332 waivers — allow states to innovate their implementation of Obamacare as long as they meet the basic ACA protections.

The Tennessee senator said Tuesday that he hopes to have a bill finalized “early next week in order to be able to hand it to Senator McConnell and Schumer in time to deal with it before the end of the month.”

Sanders’ Single-Payer, “Medicare-For-All” Bill

Sanders is scheduled to reveal his “Medicare-For-All” bill Wednesday afternoon in the Senate.

While little is known about the specifics of the legislation, a number of prominent Democratic senators have jumped on board. Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Kamala Harris of California, Mazie Hirono of Hawaii, Richard Blumenthal of Connecticut, Cory Booker of New Jersey, Brian Schatz of Hawaii, and Tom Udall of New Mexico all plan to attend Sanders announcement Wednesday. Booker, Gillibrand, Harris and Warren have also joined Sanders as co-sponsors of the bill.

The idea of a single-payer health care system was once thought to be well outside the mainstream ideological bend of the Democratic Party. No one really knows what single-payer, in the confines of the American health care system, would look like.

Traditionally, in a single-payer system, it is the government, not private insurance companies or individuals, that pays out roughly the entire cost of health care.

One thing is known for sure, Sanders has brought forth, even with a lack of details, the most popular single-payer bill to hit the national political stage. Democratic hopefuls for president in 2020 — Warren, Booker, Gillibrand and Harris — are not only throwing their weight behind the bill, they are attaching their names to it. Even the House Democratic Caucus is on board with single-payer, Politico reports.

The bill definitely has some support from high-ranking, powerful Democrats, but it doesn’t have the backing from all of the Democratic leadership. House Minority Leader Nancy Pelosi told reporters Tuesday that her focus is on protecting the Affordable Care Act.

“None of these other things, whether it’s Bernie’s, can really prevail unless we have the Affordable Care Act protected,” Pelosi told reporters.

Blumenthal, one of the most recent senators to jump on board Sanders’ bill, said Tuesday that the Medicare-For-All bill is in now way about “scrapping it (Obamacare),” the bill is rather about “building on it.”

Like Pelosi, the health insurance industry has some concerns regarding single-payer. One of the leading industry advocates — America’s Health Insurance Plans (AHIP) — does not think single-payer is the way to fix the problems with the U.S. health care system.

“The most effective way to ensure affordable care and coverage is to strengthen the private market’s ability to serve the American people, whether it’s building upon private plans serving nearly 180 million people who get their coverage through their employer or the tens of millions who depend on private plans that partner with public programs,” David Merritt, Executive Vice President at AHIP, told The Daily Caller News Foundation Tuesday.

“Whether it’s called single-payer or Medicare For All, government-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation, and place an even heavier burden on hardworking taxpayers. We should build on private-sector successes, not abandon them. Let’s work together to make health care truly affordable for the American people,” he said.

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